Healthcare Provider Details

I. General information

NPI: 1467496588
Provider Name (Legal Business Name): STEPHANIE NICOLE WRENCHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BUFORD DRIVE SUITE 200
BUFORD GA
30519
US

IV. Provider business mailing address

2800 BUFORD DR STE 200
BUFORD GA
30519-5107
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-3744
  • Fax: 678-344-3757
Mailing address:
  • Phone: 678-344-3744
  • Fax: 678-344-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3273
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: